Effectiveness of incentive spirometry in preventing postoperative pulmonary complications after laparotomy

Objective: To compare the effectiveness of incentive spirometry with deep breathing exercises in preventing post operative pulmonary complications after laparotomy

Study Design: Observational Analytic study

Place and Duration of Study: This study was conducted in the Department of General Surgery, CMH Abbotabad from Jan 2014 to Mar 2015

Materials and Methods: Total of 100 patients fulfilled the inclusion criteria. Patients of both sex and different age groups were included in the study.50 patients underwent deep breathing exercises and 50 patients underwent incentive spirometry postoperatively in addition to deep breathing exercises for five days. ABGs and the temperature was monitored for five days postoperatively. The findings were recorded and analyzed on SPSS 20

Results: The mean age for deep breathing exercises was 40 + 13.34 and for IS was 43 +12.76..the male :female ratio was 1.34:1 for deep breathing exercises and 1.8:1 for incentive spirometry. In group A 52% had no post pulmonary complications while incidence of PPC varied with grade 01 [30%] ,grade 2 [10%] and grade 3[6%] .In group B 74% had no post operative pulmonary complication while incidence of PPC varied with grade 01[18%] ,grade 02[6%] and grade 3[2%]

Conclusion: Our study showed that the use of incentive spirometry along with deep breathing exercises decreases the incidence of postoperative pulmonary complications as compared to deep breathing exercises alone

study of diabetic foot syndrome

This study was carried out to determine the number and predisposing factor of foot infection in the adult onset diabetes mellitus. An observational study. The study was carried out at PAF Hospital Islamabad, from June 2003 to June 2005. A total of 130 patients with adult onset diabetes mellitus were included in this study. The population was mixed. Clinical profile and investigations were recorded. Patients were managed as indoor cases. Plain insulin was used to control the diabetes. Broad-spectrum antibiotics and serial debridments, where required, were carried out. A total of 18.5% of the hospitalized diabetic population was due to foot infection. Males were affected 1.5 times more than the females. The disease was bilateral in 4% cases. Poor control of diabetes, bad foot hygiene, peripheral neuropathy, trauma, ingrowing toenails, callosities and corns were implicated as predisposing factors in majority of cases. Foot infection in diabetics is a common occurrence and both sexes are involved though males more commonly than females. Majority of the patients were elderly and have poor knowledge and insight of their disease

Lichtenstein repair versus darning repair in direct inguinal hernia

To compare the merits of Lichtenstein repair with Darning repair in Army soldiers having direct inguinal hernia. Study Design and A comparative, interventional clinical study in 100 cases, carried out in Combined Military Hospital, Malir, Karachi and Pakistan Air Force Hospital Faisal Base, Karachi from March 2002 to March 2004. During the study period, serving soldiers reporting to the surgical outdoor department of both hospitals were selected according to the inclusion criteria and randomly assigned to either group A [Lichtenstein repair] or group B [Darning repair]. Written informed consent was obtained from all the patients before induction in the study groups. 50 patients each were assigned to both the groups. Thorough clinical examination and laboratory profile was done to assess pro operative fitness for general anesthesia. The parameters used to assess the results were duration of stay in hospital, patient comfort and fitness, complications and recurrence. After the respective procedure, as per the group of the patients, they were followed up on day 7, 1 month, 3 months, 6 months and 1 year. On each visit thorough history and clinical examination was done to assess the condition of the patient. Physical efficiency requirements for serving soldiers were also assessed and complications noted. Overall 58% patients presented with right inguinal hernia and 39% with a left, while 3% patients had bilateral hernia. The overall incidence of postoperative complications was 10.4%. Scrotal hematoma occurred in 3% in group A and 6% in group B. The wound infection occurred in 1% of patients in group A and 3% in group B. 10% of group A and 15% of group B had postoperative pain, which required oral NSAIDS for 4-7 days. 2% patients of group B and none of group A developed urinary retention post operatively. The incidence of complications and recurrence is lower in Lichtenstein repair as compared to Darning repair, therefore, we recommend Lichtenstein hernial repair for direct inguinal hernia

Anesthesia crisis resource management

The critical scenario in which rapid response is needed, for example. Malignant Hyperthermia, occurs rarely. Hence conducting training about such clinical events leaves no alternative but to use simulation. The aims of anesthesia crisis resources management [ACRM] training are to learn principles of complex problem solving, decision making, resource management and team work behavior to improve medical and technical skills. In medical training, simulator can substitute for actual patients and recreate actual clinical environment for anesthesiologists, surgeons, radiologists, cardiologists, gynecologists, etc. for their training. Simulators range from simple mannequin to high fidelity simulators. Mannequin represents the patient, and the participants act as surgeons, anesthetists and operating room assistants in a replica of operation theatre. The high fidelity simulators are programmed to create a special situation which the trainees are required to diagnose and manage the situation and resources accordingly. A panel consisting of consultants and instructors trained in this field are observing and recording all the details on the video tape which is used later on for the debriefing sessions. Simulators have high face validity because they ease trainees' transition to actual patient. Simulators can effectively identify errors and appropriateness of decision making. There is a risk that clinician might acquire inappropriate behavior or develop a false sense of security in their skills that could theoretically lead to harm the patient. The trainees develop an underst and ing that how stresses contribute to the occurrence of error. The ACRM training is an effort to improve our underst and ing about the crisis management aiming at reducing error and ultimately improve patient safety